title: Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study.
abstract: BACKGROUND
  The contribution of sufficient sleep duration to lower CVD risk in addition to sufficient physical activity, a healthy diet, (moderate) alcohol consumption, and non-smoking has not been investigated yet.
  
  
  METHODS
  The MORGEN study is a prospective cohort study including 8128 men and 9759 women aged 20-65 years, free of CVD at baseline.
  
  
  METHODS
  Sufficient physical activity (≥3.5 h/week cycling or sports), a healthy diet (Mediterranean Diet Score ≥5), (moderate) alcohol consumption (≥1 beverage/month), non-smoking, and sufficient sleep duration (≥7 hours) were assessed by self-administered questionnaires between 1994 and 1997. Cardiovascular morbidity and mortality were ascertained through linkage with national registers. Hazard ratios and preventable proportions were calculated adjusted for age, sex, and educational level.
  
  
  RESULTS
  During 10-14 years of follow up, 607 composite CVD events (fatal CVD, nonfatal myocardial infarction and stroke) occurred, of which 129 were fatal. Those with the four traditional healthy lifestyle factors had a 57% lower risk of composite CVD (HR 0.43, 95% CI 0.31-0.59) and a 67% lower risk of fatal CVD (HR 0.33, 95% CI 0.16-0.68) compared with those with none or one healthy lifestyle factor. Sleeping sufficiently in addition to the four traditional lifestyle factors resulted in a 65% lower risk of composite CVD (HR 0.35, 95% CI 0.23-0.52), and an 83% lower risk of fatal CVD (HR 0.17, 95% CI 0.07-0.43).
  
  
  CONCLUSIONS
  Sufficient sleep and adherence to all four traditional healthy lifestyle factors was associated with lower CVD risk. When sufficient sleep duration was added to the traditional lifestyle factors, the risk of CVD was further reduced.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands Wageningen University, Wageningen, The Netherlands.
authors.forename: Marieke P
authors.initials: MP
authors.lastname: Hoevenaar-Blom
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.affiliation: Wageningen University, Wageningen, The Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands monique.verschuren@rivm.nl.
authors.forename: W M Monique
authors.initials: WM
authors.lastname: Verschuren
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D065840:Protective Factors; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012890:Sleep; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Alcohol; cardiovascular disease incidence; cardiovascular mortality; diet; healthy lifestyle; physical activity; sleep duration; smoking